Advertisement

Agreement Between Integrated Management of Childhood Illness and Final Diagnosis in Acute Respiratory Tract Infections

  • Sıddika Songül Yalçın
  • Beril Özdemir
  • Sadriye Özdemir
  • Esra Baskın
Original Article

Abstract

Objective

To evaluate the agreement between integrated management of childhood illness (IMCI) and final diagnosis in patients presenting with cough at the second and third level health institutions.

Methods

This cross-sectional study included 373 children aged 2–60 mo who presented with cough at the pediatric emergency and outpatient clinics in the Department of Pediatrics. After clinical examination of children, body temperature, respiratory rate, saturation, presence or absence of the chest indrawing, rales, wheezing and laryngeal stridor were recorded. Cases were categorized according to IMCI algorithm regarding the severity using the color code, such as red (urgent treatment), yellow (treatment in the hospital), or green (treatment at home). Final diagnosis after physical examination, laboratory analysis and chest X-ray was compared with the IMCI algorithm.

Results

Study agreement between IMCI classification and final diagnosis was 74.3% with kappa value 0.55 (moderate agreement). Similar agreement values were detected in both the second and third level health institutions. Health condition and gender did not affect agreement value. Agreement were found to be high in patients <24 mo of age (ĸ = 0.67), presence of fever and cough (ĸ = 0.54), tachypnea (ĸ = 0.93), chest indrawing (ĸ = 1.00) and oxygen saturation of <94%(ĸ = 0.90).

Conclusions

Adding saturation level to the IMCI algorithmic diagnosis may increase agreement between IMCI classification and final diagnosis.

Keywords

Integrated management of childhood illness Saturation Children Tachypnea Pneumonia 

Notes

Contributions

SSY: Composed the theme of the manuscript; BÖ and SÖ: Collected the data of the patients and wrote the manuscript; EB: Collected the data of the patients. Dr. Kadriye Yurdakok, Department of Pediatrics, Unit of Social Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

References

  1. 1.
    Kundra S, Singh T, Chhatwal J. Utility of Indian adaptation of integrated management of childhood illness (IMCI) algoritm. Indian J Pediatr. 2008;75:781–5.CrossRefPubMedGoogle Scholar
  2. 2.
    The World Health Report. 1998. Geneva: World Health Organization; 1998. p. 61–111.Google Scholar
  3. 3.
    Integrated Management of Childhood Illness (IMCI). Geneva: World Health Organization/ The United Nation Children’s Fund (UNICEF), 2014 (http://www.who.int/maternal_child_adolescent/documents/IMCI_chartbooklet/en/).
  4. 4.
    Dai Y, Foy HM, Zhu Z, Chen B, Tong F. Respiratory rate and signs in roentgenographically confirmed pneumonia among children in China. Pediatr Infect Dis J. 1995;14:48–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Taylor JA, Del Becarccaro M, Done S, Winters W. Establishing clinically relevant standards for tachypnoea in febrile children younger than 2 years. Arch Pediatr Adolesc Med. 1995;149:283–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Bryce J, Gouws E, Adam T, et al. Improving quality and efficiency of facility-based child health care through integrated management of childhood illness in Tanzania. Health Policy Plan. 2005;20:i69–76.CrossRefPubMedGoogle Scholar
  7. 7.
    Programme for the control of acute respiratory infections. WHO/ARI/90.5, 1990. p. 62–3.Google Scholar
  8. 8.
    Palafox M, Guiscafre H, Reyes H, Munoz O, Martinez H. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child. 2000;82:41–5.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    World Health Organization. Child growth standards. Available at: http://www.who.int/childgrowth/software/en/. Assessed 9 Sept. 2017.
  10. 10.
    Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.Google Scholar
  11. 11.
    Horwood C, Vermaak K, Rollins N, Haskins L, Nkosi P, Qazi S. An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa. PLoS One. 2009;4:e5937.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Jain R, Awasthi S, Awasthi A. IMCI approach in tertiary hospitals, India. Indian J Pediatr. 2009;76:725–7.Google Scholar
  13. 13.
    Mason E, Scherpbier R, Lawe-Davies O. WHO position statement on IMCI. Lancet. 2009;374:782–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Enoch AJ, English M, Shepperd S. Does pulse oximeter use impact health outcomes? A systematic review. Arch Dis Child. 2016;101:694–700.CrossRefPubMedGoogle Scholar
  15. 15.
    Nair H, Simões EA, Rudan I, et al; Severe Acute Lower Respiratory Infections Working Group. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013;381:1380–90.Google Scholar
  16. 16.
    Duke T, Wandi F, Jonathan M, et al. Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea. Lancet. 2008;372:1328–33.CrossRefPubMedGoogle Scholar
  17. 17.
    Floyd J, Wu L, Hay Burgess D, et al. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings. Nature. 2015;528:S53–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Rakha MA, Abdelmoneim AN, Farhoud S, et al. Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt. BMJ Open. 2013;3:e001852.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Sıddika Songül Yalçın
    • 1
  • Beril Özdemir
    • 2
  • Sadriye Özdemir
    • 3
  • Esra Baskın
    • 4
  1. 1.Department of Pediatrics, Unit of Social PediatricsHacettepe University Faculty of MedicineAnkaraTurkey
  2. 2.Department of PediatricsBaskent University Faculty of MedicineBahçelievlerTurkey
  3. 3.Department of PediatricsIlgın State HospitalKonyaTurkey
  4. 4.Department of Pediatric NephrologyBaskent University Faculty of MedicineAnkaraTurkey

Personalised recommendations